Basic Information
| Provider Information | |||||||||
| NPI: | 1255964250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSSELIT | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7527 | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430170727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145336497 | ||||||||
| FaxNumber: | 6145441403 | ||||||||
| Practice Location | |||||||||
| Address1: | 4002 N HAMPTON DR | ||||||||
| Address2: | |||||||||
| City: | POWELL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430658444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148427069 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2020 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0430981 | 05 | OH | MEDICAID |